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Medical Forum / General / Vision / April 2005COMET study supports a role for plus at near for myopic esophores
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12657584 A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. New England College of Optometry, Boston, Massachusetts 02115, USA. gwiazdaj@ne-optometry.edu PURPOSE: The purpose of the Correction of Myopia Evaluation Trial (COMET) was to evaluate the effect of progressive addition lenses (PALs) compared with single vision lenses (SVLs) on the progression of juvenile-onset myopia. METHODS: COMET enrolled 469 children (ages 6-11 years) with myopia between -1.25 and -4.50 D spherical equivalent. The children were recruited at four colleges of optometry in the United States and were ethnically diverse. They were randomly assigned to receive either PALs with a +2.00 addition (n = 235) or SVLs (n = 234), the conventional spectacle treatment for myopia, and were followed for 3 years. The primary outcome measure was progression of myopia, as determined by autorefraction after cycloplegia with 2 drops of 1% tropicamide at each annual visit. The secondary outcome measure was change in axial length of the eyes, as assessed by A-scan ultrasonography. Child-based analyses (i.e., the mean of the two eyes) were used. Results were adjusted for important covariates, by using multiple linear regression. RESULTS: Of the 469 children (mean age at baseline, 9.3 +/- 1.3 years), 462 (98.5%) completed the 3-year visit. Mean (+/-SE) 3-year increases in myopia (spherical equivalent) were -1.28 +/- 0.06 D in the PAL group and -1.48 +/- 0.06 D in the SVL group. The 3-year difference in progression of 0.20 +/- 0.08 D between the two groups was statistically significant (P = 0.004). The treatment effect was observed primarily in the first year. The number of prescription changes differed significantly by treatment group only in the first year. At 6 months, 17% of the PAL group versus 30% of the SVL group needed a prescription change (P = 0.0007), and, at 1 year, 43% of the PAL group versus 59% of the SVL group required a prescription change (P = 0.002). Interaction analyses identified a significantly larger treatment effect of PALs in children with lower versus higher baseline accommodative response at near (P = 0.03) and with lower versus higher baseline myopia (P = 0.04). Mean (+/- SE) increases in the axial length of eyes of children in the PAL and SVL groups, respectively, were: 0.64 +/- 0.02 mm and 0.75 +/- 0.02 mm, with a statistically significant 3-year mean difference of 0.11 +/- 0.03 mm (P = 0.0002). Mean changes in axial length correlated with those in refractive error (r = 0.86 for PAL and 0.89 for SVL). CONCLUSIONS: Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice. --------------------------------------------------------- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15223788 Invest Ophthalmol Vis Sci. 2004 Jul;45(7):2143-51. Related Articles, Links Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R, Wang Y, Everett D; COMET Grouup. New England College of Optometry, Boston, Massachusetts 02115, USA. gwiazdaj@ne-optometry.edu PURPOSE: To examine baseline measurements of accommodative lag, phoria, reading distance, amount of near work, and level of myopia as risk factors for progression of myopia and their interaction with treatment over 3 years, in children enrolled in the Correction of Myopia Evaluation Trial (COMET). METHODS: COMET enrolled 469 ethnically diverse children (ages, 6-11 years) with myopia between -1.25 and -4.50 D. They were randomly assigned to either progressive addition lenses (PALs) with a +2.00 addition (n = 235) or single vision lenses (SVLs; n = 234), the conventional spectacle treatment, and were observed for 3 years. The primary outcome measure was progression of myopia by autorefraction after cycloplegia with 2 drops of 1% tropicamide. Other measurements included accommodative response (by an open field of view autorefractor), phoria (by cover test), reading distance, and hours of near work. Independent and interaction analyses were based on the mean of the two eyes. Results were adjusted for important covariates with multiple linear regression. RESULTS: Children with larger accommodative lags (>0.43 D for a 33 cm target) wearing SVLs had the most progression at 3 years. PALs were effective in slowing progression in these children, with statistically significant 3-year treatment effects (mean +/- SE) for those with larger lags in combination with near esophoria (PAL - SVL progression = -1.08 D - [-1.72 D] = 0.64 +/- 0.21 D), shorter reading distances (0.44 +/- 0.20 D), or lower baseline myopia (0.48 +/- 0.15 D). The 3-year treatment effect for larger lags in combination with more hours of near work was 0.42 +/- 0.26 D, which did not reach statistical significance. Statistically significant treatment effects were observed in these four groups at 1 year and became larger from 1 to 3 years. CONCLUSIONS: The results support the COMET rationale (i.e., a role for retinal defocus in myopia progression). In clinical practice in the United States children with large lags of accommodation and near esophoria often are prescribed PALs or bifocals to improve visual performance. Results of this study suggest that such children, if myopic, may have an additional benefit of slowed progression of myopia Thanks for pointing out a topic that has been discussed several times in this NG previously. Myopic esophores are a group likely enriched in patients who are accommodative myopes. These people have increased accommodative tone (with a concomitant increased convergence-- hence the esophoria). This is the only subgroup of myopes where plus lens therapy could be useful. We have discussed this a gizillion times with good ol' Otis over the last two years, and now you rediscover it and think you've stumped all the eyedocs. Now what about all the myopic orthophores, or exophores? They constitute 90%+ of the total population of myopes? Rishi says the sungod Ra cures all eye problems. Otis repeats over and over and over (and over) again that plus lenses work when the data says not! Andrew says stress without any proof or even rational argument. Eyedocs say a combination of genetic and environmental influences that haven't been identified yet. I'm sure your about to pontificate what Andrew thinks. > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? > cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12657584 [quoted text clipped - 4 lines] > > children. snip description of the study> RESULTS: Of the 469 children (mean age at > baseline, 9.3 +/- 1.3 years), 462 (98.5%) completed the 3-year > [quoted text clipped - 9 lines] > > observed primarily in the first year. In other words, the treated group needed -1.25D correction and the untreated group -1.50D. The effect, 0.25D, is clinically insignificant. Both groups continued to need glasses and both groups progressed. major snip > The small magnitude > > of the effect does not warrant a change in clinical practice. That conclusion says it all -- the effect is too small to justify using plus lenses. snip rest of message ok so you wonder why i post a study that supports what you have been talking about for years? Dr Judy has explained why. She read the first study results and saw that they were not statistically significant. That confirmed her opinion and she appears to have read no further. Remember please that higher myopia is not just higher myopia corrected by similar looking glasses but it also carries increased risks of significant damage to the eyes. The Second study results (which are a continuation of the first) suggest there is a role for plus. "Statistically significant treatment effects were observed in these four groups at 1 year <after the first study- aej> and became larger from 1 to 3 years." "CONCLUSIONS:" "Results of this study suggest that such children, <the esophores -aej> if myopic, may have an additional benefit of slowed progression of myopia" Slowing myopic progress is not something to be so lightly dismissed surely? The Pope > ok so you wonder why i post a study that supports what you have been > talking about for years? [quoted text clipped - 7 lines] > similar looking glasses but it also carries increased risks of significant > damage to the eyes. High myopia is not the cause of retinal detachment, it is a marker for eyes that at risk of detachment. Increased axial length is a risk factor for detachment and eyes with longer axial length tend to be myopic. Therefore, high myopia is a good clinical tool to use in predicting which eyes might have long axial length and should be examined more frequently. It is however, possible for long axial length to exist without myopia and for high myopia to exist without long axial length. And by high myopia we mean over -6.00 > The Second study results (which are a continuation of the first) suggest > there is a role for plus. [quoted text clipped - 9 lines] > if myopic, may have an additional benefit of slowed progression > of myopia" > Slowing myopic progress is not something to be so lightly dismissed > surely? The very small effects seen in both these studies (less than 1.00D over 3 years) will not prevent 6.00 myopes nor prevent long axial length. As RM stated, myopic esophores are rare, less than 10% of myopes. In practice, I always cycloplege esophores, to make sure they are not over accommodating. Dr Judy >>It is however, possible for long axial length to exist without myopia Makes sense. The human body is an amazing collection of differently sized parts that all link together in 99% of cases to produce a fully functioning healthy body. Myopia being the exception to this. Dr Judy >>As RM stated, myopic esophores are rare, less than 10% of myopes. In practice, I always cycloplege esophores, to make sure they are not over accommodating. I once used the word 'common' to describe identical twins who have more than 6d of refractive error *difference*. I braced myself for an attack on that word 'common' but found I was in the clear. http://www.who-umc.org/defs.html#FREQ Very common > 10% Common (frequent) > 1% and < 10% Uncommon (infrequent) > 0.1% and < 1 % Rare > 0.01% and < 0.1% Very rare < 1/10,000 So "myopic esophores are rare, less than 10% of myopes" Do you mean "myopic esophores are common, being almost 10% of myopes"? Or something else? Andrew > Dr Judy > [quoted text clipped - 17 lines] > > Do you mean "myopic esophores are common, being almost 10% of myopes"? Whether we call it common or rare, the fact is that 9 out of 10 myopes are not esophoric and the plus won't help. Now lets look at this from a clinical perspective. Most myopes start myopia around age 12 and progress until about age 18 then stop progressing. To maximize effects, let's assume start at age 10, progressing until age 19 which gives three three year intervals. Using the Comet data, the esophores using plus progress between 0.87 and 1.29D per three year period. The esophores not using plus progress between 1.50 and 1.93D per three year period. Assume myopia is discovered at age 10 at 0.50 and treatment starts. At age 19 the treated esophores refractive errors will be between -3.25 and -4.50. The untreated esophores refractive errors will be between -5.00 and -6.25. Some slowing but is it enough to convince parents to spend triple the cost on glasses? Dr Judy Dr Judy said >>Whether we call it common or rare, the fact is that 9 out of 10 myopes are not esophoric and the plus won't help. Which means that according to WHO definitions its *very* common for those who the plus will help:-) http://www.who-umc.org/defs.html#FREQ >>Now lets look at this from a clinical perspective. Most myopes start myopia around age 12 and progress until about age 18 then stop progressing. To maximize effects, let's assume start at age 10, progressing until age 19 which gives three three year intervals. >>Using the Comet data, the esophores using plus progress between 0.87 and 1.29D per three year period. The esophores not using plus progress between 1.50 and 1.93D per three year period. Assume myopia is discovered at age 10 at 0.50 and treatment starts. >>At age 19 the treated esophores refractive errors will be between -3.25 and -4.50. The untreated esophores refractive errors will be between -5.00 and -6.25. Some slowing but is it enough to convince parents to spend triple the cost on glasses? Thanks for doing that it makes it much clearer. Otis is always going on about the second opinion and prevention with no evidence whatsoever. But in this particular case he would have a point. For many parents this treatment would result in a very signifcant improvement in their childs uncorrected vision. Are you saying you will suggest this treatment regime for parents who can afford it? It seems simple to explain to the poorer parents of the very commonly esophoric myopic children that there is a very high likely hood of a less rapid development of the existing myopia and that their children are likely to get significant reductions in the probablity of major eye problems later in life if they use some kind of plus regime (which may only be just drug store glasses worn over the glasses they do have). Given this information the rest is their decision. Andrew >> For many parents this treatment would result in a very signifcant > improvement in their childs uncorrected vision. Are you saying you will > suggest this treatment regime for parents who can afford it? No. Uncorrected acuity of a 3.00D myope approaches 20/400, iuncorrected 4.50 is worse than 2/400. Uncorrected acuity of 5.00 to 6.25 myopes is, in practical, real world terms, not a lot worse than the uncorrected acuity of the -3.00 to -4.50 myopes. So, at the end of the day, all the treated esophoric myopes and all the untreated esophoric myopes are going to be wearing glasses full time after age 18. The only advantage of treatment is thinner glasses. I think I would have trouble recommending therapy that involves having children use $400 to $600 progressive glasses instead of $150 single vision glasses, based on the above outcomes. > It seems simple to explain to the poorer parents of the very commonly > esophoric myopic children that there is a very high likely hood of a less [quoted text clipped - 4 lines] > in life if they use some kind of plus regime (which may only be just drug > store glasses worn over the glasses they do have). The evidence says nothing about lessening eye problems and that statement cannot be made, it is only valid to say they would have slightly thinner glasses. Dr Judy Dr Judy said: >>The evidence says nothing about lessening eye problems and that statement cannot be made, it is only valid to say they would have slightly thinner glasses. I am struggling here to understand precisely what you are saying. Is there not a clear link/risk associated with retinal detachment and high myopia? Does this not therefore mean that there is a clear link/risk associated with thick minus lenses? And therefore some duty/obligation for an eye doctor to offer treatments which address that link/risk? In the case of esophoric myopes we are talking about a very commonly occurring condition amongst myopes according to your own figures and WHO definitions. Something that you describe as rare using your own definition of rare. Seems a bit of bias is coming into your answer here. Andrew > And therefore some duty/obligation for an eye doctor to offer treatments > which address that link/risk? Misleading question. Don't you really mean "every treatment ever conceived, no matter how effective?" > In the case of esophoric myopes we are talking about a very commonly > occurring condition amongst myopes according to your own figures and WHO > definitions. Something that you describe as rare using your own > definition > of rare. Seems a bit of bias is coming into your answer here. Never mind it's the higher myopes who get detachments, and the higher the myopia, the higher the heritability. Oh, that's right. Myopia can't be genetic. -MT Mike Tyner said Andrew judd said >> And therefore some duty/obligation for an eye doctor to offer >>treatments >> which address that link/risk? >Misleading question. >Don't you really mean "every treatment ever conceived, no matter how effective?" I dont see why my question is misleading and why you have wished to transform my response that is essentially "in the case of the very commonly occuring esophoric myopes use of plus *might* be a reasonable option to consider for those *wanting* to follow that route to that of "every treatment ever conceived, no matter how effective?" >> In the case of esophoric myopes we are talking about a very commonly >> occurring condition amongst myopes according to your own figures and >>WHO definitions. >Never mind it's the higher myopes who get detachments, and the higher the myopia, the higher the heritability. I think you are getting confused. For example when Terri Young OD did the fabulously expensive gene linkage study that found no genes linked but significant chromosome linkage on some of the 22 members tested of a large canadian family one myope was flagged earlier in the piece who "must have genetic high myopia" because he had myopia of -50D. Other family members were found to have myopia and therefore it "must be genetic high myopia". No discussion of family factors was shown in the study. Meanwhile these kinds of "mendelian high myopia" gene studies are 'showing' that each family has different chromosomes linked to the myopia present in that particular family. Aside from this rather silly science are there are other studies that show high myopia is more genetic than low myopia? Perhaps they exist but i have not seen them. If they do exist why are their still studies going on to show the genetic relationship? >>Oh, that's right. Myopia can't be genetic. I have never said that. Instead i have simply asked where is the science that shows that? Cant we just stick to science rather than only opinion? Andrew > I dont see why my question is misleading and why you have wished to > transform my response that is essentially "in the case of the very [quoted text clipped - 3 lines] > treatment ever conceived, no matter how > effective?" Plus treatment is one of the techniques we use for functional myopia, also known as accommodative spasm and pseudomyopia. Most young myopes have some excess accommodatiion. When they have a lot, it makes them esophoric. This is not anatomical myopia. It is functional. It only affects young myopes, and it resolves spontaneously over time. Whether it resolves with age, with biofeedback, with plus lenses, or with prayer, the eye doesn't get shorter nor does the cornea flatten. If accommodative spasm resolves spontaneously, why must we treat it earlier with special lenses that make driving difficult? > I have never said that. Instead i have simply asked where is the science > that shows that? I usually start with the current Myopia chapter of Duane's Ophthalmology. I realize that's an appeal to authority and you don't accept authorities. > Cant we just stick to science rather than only opinion? Ah.. like infants born with astigmatism have parental conflicts? -MT Mike Tyner said >>Plus treatment is one of the techniques we use for functional myopia, also known as accommodative spasm and pseudomyopia. I get the impression your mind is set in concrete. The comet study specificly mentions that all myopes were cyclopleged to determine amount of myopia. But you seem to be dismissing this study because myopes were not measured for axial elongation before and after? You guys are unbelievable! When there is next to no evidence that myopic is genetic you make claims the genes have been found and the twin evidence which ignores environmental factors is lauded as good evidence of 80% heritability of myopia. And yet when there is in this one case good evidence that for some myopes plus *might* be effective you keep your heads buried in the concrete unable to believe that even possibly this study *might* suggest that plus *might* possibly be effective and just *possibly* what you were taught was wrong. This place is more like a kindergarten where bullies go around punching up anybody who offers an opinion that does not fit the already decided group view. Otis is insane but what the hell are you people! God knows! Andrew > Cant we just stick to science rather than only opinion? Err.. OK, then lets stick to the science that says myopia is caused by anxiety, and astigmatism is caused by parental conflicts. And that science is.... where exactly ...? > Dr Judy said: > [quoted text clipped - 6 lines] > Is there not a clear link/risk associated with retinal detachment and high > myopia? High myopia is simply a marker for those with long axial length which is the risk factor. The study did not look at the difference in axial length of treated vs untreated esophoric myopes nor did it look to see if the risk of retinal detachment was affected. That is why it is not valid to say that the risk of disease is affected. The treatment effect was small, about 2D difference at most. So the risk reduction, if any, is also small. Finally, the risk of detachment is associated with myopia over 6D, most of the untreated group never get over 6D. Dr Judy > High myopia is not the cause of retinal detachment, it is a marker for > eyes that at risk of detachment. Increased axial length is a risk [quoted text clipped - 4 lines] > length to exist without myopia and for high myopia to exist without > long axial length. And by high myopia we mean over -6.00 There's a more fundamental question here. The prevention groups always point out that high myopia is associated with retinal detachment, but they never discuss whether those destined for high myopia can arrest the myopia with any of the treatments suggested, or whether this high myopia is a different creature altogether Scott Scott said >>There's a more fundamental question here. The prevention groups always point out that high myopia is associated with retinal detachment, but they never discuss whether those destined for high myopia can arrest the myopia with any of the treatments suggested, or whether this high myopia is a different creature altogether This is a good question. High myopia appears strongly related to psychological characteristics amongst the myopes I have interviewed. (Many -6's and one -10 case observed) . If high myopia over -6D is a different beast to school myopia then the case for psychological characteristics being causal to myopia would be considerably weakened. Even if psychological characteristics could be inherited, I would be reluctant to say that these characteristics, as inherited characteristics, cause myopia. I am prepared to say that myopia appears to be created by specific environmental events and circumstances rather than being related to genetic personality correlates. If genetic high myopia is proven as something that exists for all high myopes then my argument is weaker. Andrew > Slowing myopic progress is not something to be so lightly dismissed > surely? No. But if we start some "therapy to slow myopia," Mom will talk it over with her pediatrician and he'll insist that she take the kid to a "real doctor." That's the reality. -MT Dear Prevention minded friends, Both Mike and Judy are absolutly correct. If they suggest the "bifocal" the parents will recoil in fear! There are several reasons for this. 1. As the studies show -- the kids AVOID looking through the small-segment plus. Thus these studies have hardly any meaningful scientific content -- when you realize this scientific fact. 2. For the plus to be truly effective -- it MUST start before a minus lens is used. 3. If Mike and Judy are involved their "shop rate" is at least $100 per hour. (They have to make a living you know.) 4. As per Raphaleson's "The Printer's Son", the young person must both USE THE PLUS and SEE THE RESULTS. 5. Unless the person has this type of motivation (like a pilot who MUST protect his vision) the plus can not be used. But all this suggests that we must "change" our attitude towards prevention. I would gladly PAY a "professional", and sign a "contract" if he would discuss these "issues" with me BEFORE he placed a minus lens on my face. This would be an "either-or" choice. Once I start wearing the minus -- there can be no future "clearing" with a plus lens. Again, Francis Young ran the "correct" bifocal study, because he used a very high "plus" segment. The effect of the plus was to stop further movement into nearsighedness. The single-minus group when down at about -1/2 diopter per year. This suggests that a person on the threshold could AGRESSIVELY use the plus as "Jon" did -- and clear his vision (under his OWN CONTROL) to 20/20. Best, Otis Engineer Mike Tyner said >>No. But if we start some "therapy to slow myopia," Mom will talk it over with her pediatrician and he'll insist that she take the kid to a "real doctor." >>That's the reality. On a similar vein I was considering the implications of an identical twin study finding mental health factors being important in myopia development (were that to happen). I imagine it would be difficult to get past the ethics committee for an already established group of twins previously recruited to help human kind, since all myopes in that group (not just the discordant identical twins) would then have the label of 'has emotional problems' Then there would the difficulties of recruiting a new twin group. The ethics committee would insist they were all aware of the nature of the study. Then there would be the conclusions of the naysayers who say 'the recruitment process was distorted' :-( Dear Mike, At last you described the real truth of this difficult situation. If we all acknowledge this truth -- that the parent MUST go through an "educational" process BEFORE anything it done -- then a better PREVENTIVE future is possible. This is EXACTLY the situation described by Raphaelson 100 years ago. When I acknowledge this sad truth -- you proceed to attack me, by insisting that the concept of PREVENTION must be destroyed. We all bear responsibility for this situation. If we would stop "fighting" about the dynamic nature of the natural eye (proven in science -- but no in "medicine") we might be able to begin a process of true-prevention. Best, Otis Engineer > When I acknowledge this sad truth -- you proceed to > attack me, by insisting that the concept of PREVENTION > must be destroyed. Nonsense. I insist that the concept of prevention must be PROVEN. As soon as you offer proof that it works, I'll use your technique, and so will every other doctor. What's stopping us? -MT > Nonsense. I insist that the concept of prevention must be PROVEN. Please explain how you can prove something that happens to one individual and cannot be counter-proven. > As soon as you offer proof that it works, I'll use your technique, and so > will every other doctor. If proof is that in one control group there is one slight improvement against the normal statistical average... Are you able to say that the sligh timprovement will be achieved to the given patient under your cure? Is it clear? > What's stopping us? Are you able to put a pair of glasses on a given client and predict how he will react? You speak as if your treatments are PROVEN. It seems to me they are not. You have only a set of statistical groupings. You do not know WHO is going to be part of a certain group. It is not very much a scientific thing. Nonsense. I insist that the concept of prevention must be PROVEN. As soon as you offer proof that it works, I'll use your technique, and so will every other doctor. This depends on WHAT is to be proven -- and to WHOM! There are two questions: 1. Is the natural eye a sophisticated system? 2. Does the refractive status of the natural eye, change -- when you apply quantative "step-input" to the system. 3. Jan-ODs statement that the natural eye "IS NOT DYNAMIC" WILL BE TAKEN SERIOUSLY. Let him put his money where his mouth is. 4. This is a pure-scientific test -- not medical 5. The conclusions and PROOF concern the natural eye when tested on a "input" (step change) versus "output" (NEASURED refractive state). And yes, you can use atropine on primates. These will be adolescent primates. 6. Are you willing to put up money to guarantee that the natural eye is proven to be NOT DYNAMIC? Further, your problem is that you do not see the forest for the trees. You are examining the bark on one tree and looking for "problems" witht the bark. That tells you NOTHING about the over-all or general behavior of the natural eye. The issue concerns the words we use to describe the behavior of a natrual system. But let us continue to enjoy the analysis of the natural eye as a sophisticated system. If you wish to tell me that the general public has a "short fuse" and will not accept advice to use the "preventive" plus lens -- that is fine with me. That would be more truthful and honest than anything else you have said thus far. Best, Otis What's stopping us? -MT > When I acknowledge this sad truth -- you proceed to > attack me, by insisting that the concept of PREVENTION > must be destroyed. > This depends on WHAT is to be proven -- and to WHOM! > > There are two questions: More nonsense. There is ONE question - do children who wear plus get less nearsighted than children who don't? As soon as you show us this is true, we will employ your technique on every young myope we see. I promise. -MT Dear Mike, What is stopping you is your OD boards. Your OD boards are made up of ODs like Jan-OD who shout, "the concept of the natural eye as dynamic ... must be destroyed". So much for a rational analytic approach to preventing the development of a negative refractive state for the natural eye. The few pilots who manage to figure this out -- and maintain control of their distant vision -- avoid all these problems -- not to mention the costs of yearly changes in "prescriptions". Further they have the satisfaction of defeating a difficult scientific problem that you can not seem to understand. Best, Otis > What is stopping you is your OD boards. More nonsense, Otis. What's stopping us is there is not a single study that shows clear-cut benefits of plus therapy. As soon as you publish one, we can show it to our boards and to the Federal Trade Commission as evidence we should be allowed to advertise this miraculous technique. > Your OD boards are made up of ODs like > Jan-OD who shout, "the concept of the natural > eye as dynamic ... must be destroyed". I've never heard them say that. How many optometry board members have you spoken with? How many efficacy studies can we show them, Otis? > So much for a rational analytic approach to > preventing the development of a negative > refractive state for the natural eye. So much for that study showing plus prevents nearsightedness. > Further they have the satisfaction of defeating > a difficult scientific problem that you can not > seem to understand. Too bad they haven't published a single study showing plus more effective than placebo. Why is that, Otis? -MT Mike Tyner said >>Too bad they haven't published a single study showing plus more effective than placebo. Not sure what you are saying here Mike There are studies showing plus to be more effective in some form than pure minus for some myopes. If you make a misleading statement like the above it only encourages surely? Andrew > There are studies showing plus to be more effective in some form than pure > minus for some myopes. Functional myopia is different from anatomical myopia. Most young myopes have both. We know that functional myopia responds to treatment. It also resolves spontaneously, in time, so it isn't necessary to treat it with special lenses or hypnotherapy or crystals or proprietary incantations. There are plenty of web sites that offer those services. It's structural myopia we're concerned about. When you actually measure axial length and curvature, then plus treatment, undercorrection, overcorrection, no correction - none of them make enough difference to matter. If you find evidence that they do, please let us know so we can offer this valuable therapy. > If you make a misleading statement like the above it only encourages > surely? The misleading statement is that every myope should be offered every possible treatment, effective or not. -MT >>The misleading statement is that every myope should be offered every possible treatment, effective or not. Agreed but i never said that so why do you keep implying that i did! Are you an independant observer here or are you employed to to be disruptive by some vested interest? Andrew > Your OD boards are made up of ODs like > Jan-OD who shout, "the concept of the natural > eye as dynamic ... must be destroyed". ha ha ha what a fool you are Otis. > The few pilots who manage to figure this out -- and > maintain control of their distant vision -- avoid > all these problems -- not to mention the costs > of yearly changes in "prescriptions". Oh-- so we're back to talking about the "intelligent pilot" subsegment of the patient population. Otis, you think everything is about conspiracy theories and people trying to do harm to other people in order to gain a monetary advantage. What a simpleton you are. PROVE YOUR PLUS LENS THEORY WORKS AND IT WILL BECOME THE STANDARD OF CARE. IF YOU DON'T PROVE IT, NO ONE WILL LISTEN TO YOU. Mike, To the unknowledgeable (namely me :), this discussion raises some questions. You may feel these questions are just restating the comments of Andrew or Otis or whoever, but I am curious. Please indulge me. In the OD's opinion.... Is there a simple way to determine whether an individual is a functional or anatomical myope? Is it possible that minus lenses can harm or exacerbate the severity of myopia in an individual? If the myopic condition started as functional will it necessarily change to an anatomical one with age, time, damage, use of minus lenses? What percentage of myopia is functional vs anatomical? Thanks, Jamie Also Dr. Judy mentioned (somewhere in one of these forums) that the majority of myopia starts at something like the age of 10. I believe she stated that the condition deteriorates (on average or for the majority) by the age of 19. Are these more recent statistics? Or have these stats been constant for 100 years? My perception is that there are many more myopes today then there were even 25 years ago and that there are more and more young myopes today. Is this perception accurate? My myopia started (that I know of) between 17 and 18. It has slowly gotten worse in the past 17 years (I am now 35). I am now ~ -3.5. Am I a typical case? Is it possible to determine what type of myope I am? My mother's myopia reversed over a 5-10 year period starting in her late 50's. Thanks! Is the following study well known in general and by the group here? I have heard the 0.5D improvement that people can make. The abstract below does not state exactly what improvements were made. I am curious.... 1: Biofeedback Self Regul. 1981 Dec;6(4):547-62. Related Articles, Links Biofeedback of accommodation to reduce functional myopia. Trachtman JN, Giambalvo V, Feldman J. Functional myopia may be defined as the refractive condition of the eye due to spasm of the ciliary muscle. As a result of the ciliary muscle spasm, the crystalline lens becomes more convex, creating a myopic refractive condition. The normal increase and decrease in the refractive power of the crystalline lens is know as accommodation and is controlled by the autonomic nervous system innervation to the ciliary muscle. Previous studies have reported that voluntary control of accommodation is possible by biofeedback training (Cornsweet & Crane, 1973; Randle, 1970). The present research investigated the application of biofeedback control of accommodation to reduce functional myopia. A double-reversal, multiple- baseline design was used to conduct the experiment. The results revealed that the three adult male subjects achieved the preset criterion, a 1/2- diopter reduction from initial baseline to a subsequent baseline. Further analysis of the data revealed even greater changes between initial baseline and feedback periods. Although generalization to a nonexperimental environment was not trained, each subject showed a reduction in myopia and an increase in visual acuity. The results of the experiment clearly demonstrated that functional myopia is subject to voluntary control. Publication Types: Case Reports PMID: 7326275 [PubMed - indexed for MEDLINE] I do think that the incidence of myopia is increasing in certain demographics. This is not based on any scientific survey, but my own Middle School Survey. Since I have been speaking to the students at a single middle school in my community for the past 15 or 20 years, I have taken regular polls. I simply ask the students who wear contact lenses or eyeglasses to raise their hands. When I started, the percentage was roughly 20 - 25%. More recently it is 40 - 50%. My own theory is that children spend more time doing nearpoint activities. I blame the computer and the internet. Given the rather late onset of your myopia, I would guess that there would be a large functional component. You could find out by undergoing a complete cycloplegic refraction with cyclopentolate or other strong cycloplegic agent such as atropine (if you don't mind being dilated for several days). DrG > I do think that the incidence of myopia is increasing in certain > demographics. This is not based on any scientific survey, but my own [quoted text clipped - 5 lines] > theory is that children spend more time doing nearpoint activities. I > blame the computer and the internet. How does this correlate with "vision insurance" prevalence? When I was a kid, in my neighborhood, you really had to squint to be a candidate for glasses, because your folks probably couldn't really afford them. FWIW. Kay Very good question, and one worthy of consideration. My response would be that vision screenings have been conducted within the school district for the past 20+ years. To my knowledge, the pass/fail criteria haven't changed. Children who fail the exam are referred to an eye specialist. Local financial resources have always been available from organizations such as the Lions Club. Also, I donate my services for the needy. DrG > Very good question, and one worthy of consideration. > [quoted text clipped - 4 lines] > been available from organizations such as the Lions Club. Also, I > donate my services for the needy. My grade school days were 45 years ago. I recall an encounter with an E chart in kindergarten, hearing screening in the 4th grade, and a rather cursory screening with a Snellen chart about 8th grade (I was pretty sure that a Snellen chart wasn't designed to be read while blowing in a breeze.) Other than that, the school nurse did heights, weights and took care of playground scrapes. <g> Nice to hear things are getting better in screening exams. Kay, the bookworm, who's been wearing basically the same -1 or -1.25 scrip since 8th grade, and now uses +0.75 readers once in awhile. > > Very good question, and one worthy of consideration. > > [quoted text clipped - 15 lines] > Kay, the bookworm, who's been wearing basically the same -1 or -1.25 scrip > since 8th grade, and now uses +0.75 readers once in awhile. ...case in point why nobody has found a global explanation for myopiagenesis. Also, your remark about vision insurance haunted me. IMHO, vision insurance has totally wrecked eye care. It used to be that patients got their eyes examined and glasses when necessary. Business was good. Now, it seems as though they don't even do it when necessary if they don't have insurance. It is as though "If I don't have coverage, I won't get an eye exam. I'll wait until hell freezes over, I am blind, or have vision coverage." DrG >> Kay, the bookworm, who's been wearing basically the same -1 or -1.25 > scrip >> since 8th grade, and now uses +0.75 readers once in awhile. > > ...case in point why nobody has found a global explanation for > myopiagenesis. Yup. As likely as finding a single cause for all cancers. > Also, your remark about vision insurance haunted me. IMHO, vision > insurance has totally wrecked eye care. It used to be that patients > got their eyes examined and glasses when necessary. Business was good. I think it was more like "those who could afford it". My mom's been badly astigmatic her entire life. She got glasses in third grade, and wore the same pair through high school and to work. (Yes, Great Depression baby!) Someplace along the road, the glasses got broken and she learned to get along without them for the most part. Sometime in the mid 1960's, she finally got her eyes examined again, and new glasses... and has continued to have new glasses every couple of years since. My father never had a vision exam until he went into the army in 1941; was given glasses that are probably about -1, and never wore them again until he turned about 45, started putting the phone book on the kitchen chair and backing into the living room to read it, and then got bifocals. > Now, it seems as though they don't even do it when necessary if they > don't have insurance. It is as though "If I don't have coverage, I > won't get an eye exam. I'll wait until hell freezes over, I am blind, > or have vision coverage." I show up every year or two, mostly because I'd like someone to check out my retinas and optic nerves, etc... there are enough detached retinas and AMD in my family to make that prudent. I'm legal to drive without my glasses, but I prefer the acuity they offer and wouldn't care to put myself and the rest of the world at risk when I can see so much better with glasses. Tried contacts, didn't much care for them. Found glasses are quite useful for protecting eyes from physical damage like getting swatted in the face by twigs and branches, too. Kay As a post-script, children in middle school probably began their myopia in grade school. By the time a myopic child has reached middle school, i.e. 7th grade, the myopia would probably be difficult to ignore, even by the most recalcitrant. DrG DrG You stated the following: "Given the rather late onset of your myopia, I would guess that there would be a large functional component. You could find out by undergoing a complete cycloplegic refraction with cyclopentolate or other strong cycloplegic agent such as atropine (if you don't mind being dilated for several days). DrG" I believe the last time I had a cycloplegic refraction was maybe 4 years ago. I think the dialation lasted for maybe 3-7 hours. I can't remember exactly and I am not sure that would tell you which agent was used. If I remember correctly the prescription I was given was maybe 1.0D less than what I currently have. Of course my memory could be failing me. Ok, I know I am going round and round but....if my vision has a large functional component to it and if it always has had a large functional component to it, then is it possible that I have been in some sort of "functional-induced downward spiral"? Let's assume I am over-prescribed by 1.0D. If I reduced my prescription by 1.0D and allowed myself to adjust, then overtime maybe there would be another layer to the onion so to speak. Maybe there would be another functional component that could be removed as well???? So if I am currently approx. -3.5D, then maybe I could ultimately reduce my prescription to say -1.75D. What are your thoughts? > well???? So if I am currently approx. -3.5D, then maybe I could ultimately > reduce my prescription to say -1.75D. Remember well that the numbers you quote have no real meaning as far as your cure is concerned. To jump off from these strange and contradictory data is one great step towards a complete cure. Once you understand that you can have flashes of perfect sight without glasses, where are the dioptres going (cyclo or not)??? Think about it. Do you think your flashes of perfect sight are related to lacrimal tear, to depth of focus, or something like that??? Or just they mean that for a few seconds your eye was again normal??? Think about that. If you think well, you will discard the whole conspiracy of the idiots who try to manipulate you with all sorts of data, nonsensical, invented and false. Rishi, I agree with you in this point - most of the time. At times my confidence is 100%. But then when my vision regresses, I lose my belief. I know it is very weak of me. At those moments when I have clear flashes (like when I can clearly see a stop sign or street sign from 70m when normally I would have to be 5m to see it blurry), I am blown away and overwhelmed. Right now my confidence would increase if I could increase the duration of my clear flashes. My longest is around 20-30 seconds. If I could make a clear flash last 5 or 10 minutes then I would be a very happy man. Any thoughts? > Rishi, > > I agree with you in this point - most of the time. At times my confidence > is 100%. But then when my vision regresses, I lose my belief. Relapses are part of the cure in most of the cases. > I know it is very weak of me. It is simply normal, as things are. > At those moments when I have clear flashes (like when I can clearly see a > stop sign or street sign from 70m when normally I would have to be 5m to > see it blurry), I am blown away and overwhelmed. Don't think this way! It is normal and natural that your eyes want to see! > Right now my confidence would increase if I could increase the duration of > my clear flashes. My longest is around 20-30 seconds. If I could make a > clear flash last 5 or 10 minutes then I would be a very happy man. Again a wrong set of thoughts. You cannot do anything to get a better vision, direvtly. All you have to do is practicing the methods of the normal eye until they are back to you forever. 30 seconds are a very great success! You should be happy! Problem is that by using the ugly eyeglasses you are destroying the wonderful work you are doing, and this is why you cannot raise or improve your non-flash vision, which is still very poor, I guess. http://TheCentralFixation.com You are right. My non-flash vision is still poor. I will make more of an effort to get rid of my glasses altogether. I am taking out my contacts (reduced prescription) and will work the rest of the day without anything. I will then see if I can do this everyday even at work. This would be a big step for me. Even though you obviously mind-meld with Rishi, your use of logic gave you away. No, this is not an onion layer phenomenon. One has a finite amount of functional myopia. Unfortunately, the measurement of it is not always consistent, even under "cycloplegia." Perhaps it was underestimated in the past. DrG Leukoma said >One has a finite amount of functional myopia. Unfortunately, the measurement of it is not always consistent, even under "cycloplegia." What kinds of variation would be likely? The comet study is using "Five consecutive, reliable measurements of sphere, cylinder, and axis were performed on each eye, using the Nidek ARK 700A autorefractor, approximately 30 min. after installation of two drops of 1% tropicamide spaced 4 to 6 min. apart. " Andrew > Leukoma said > [quoted text clipped - 10 lines] > > Andrew Dear Andrew, I have had the occasion to perform "cycloplegic" examinations on young children which failed to elicit the full amount of hyperopia as confirmed by another subsequent cycloplegic refraction. Please remember that I have been doing this dozens of times/day for more than 20 years. Let's just say that it is possible that the accommodative component is subject to measurement error and leave it at that. This is the problem when a patient reports their singular experiences with one or two eye exams/eye docs, while we eye docs are drawing from a much larger sample size. I am sure that the COMET study has some statistical validity. Naturally, if you have a better method, please feel free to share it with the group. Now, please quit being a gadfly. DrG >> Leukoma said >> [quoted text clipped - 29 lines] > >DrG Incidentally--and just maybe apropos of nothing--my cycloplegic Rx was, for years, written as app. +6d, yet I was constantly experiencing severe symptoms of eyestrain. Only after years of seeking relief was I put on four days of Atropine which, along with giving relief of symptoms for the first time, showed that I'm very nearly a +8d. To this day, off of cycloplegics (which I was using nightly for about two years), I return to about 3d of tonic accommodation. I'm not sure how common *this* sort of issue is, but it speaks to yet another potential reason for variability in cycloplegic results. Exactly my point. Thanks for posting that. DrG Dear DrG I was simply attempting to understand better how the eye behaves when cyclopleged. Given that there are still studies going on the behaviour of accommodation and influences of sympathetic innervation etc etc Variation would be interesting dont you think? As there is another thread running that says autorefractors are never used to get final results (which conflicts with what i have been anecdotally told) I was curious to get the full oil so to speak. Its the nature of this subject that to get a fully informed opinion its necessary to listen to the views of more than one person so that what is known and what is only guessed at can be seen in that light. Thanks Andrew > As there is another thread running that says autorefractors are never used > to get final results (which conflicts with what i have been anecdotally > told) I was curious to get the full oil so to speak. Never say never, but any doctor who routinely prescribes from his autorefractor will have lots of unhappy patients and remake a lot of glasses. -MT DrG, I try to use logic to the best of my ability. Like all (or most) people my emotions, obsessions, fears, etc. can get in the way of my reason. There is a very rational explanation for the willingness to give any form of natural vision improvement a go; there are no non-invasive, surgical alternative for a cure and, as far as I know, you cannot harm yourself by not wearing your glasses. Can we agree on these points or have I missed something? I am specifically referring to myopia in the above post. >DrG, > [quoted text clipped - 7 lines] > >Can we agree on these points or have I missed something? Whenever you embark on a program like this, you would be well advised to be under the care of a competent OD or MD throughout. One critical factor is to get an accurate sense of your cycloplegic refraction (with accommodative mechanism paralyzed) at the baseline and throughout. What you're likely to find is an increasing reliance on your accommodative system, rather than any underlying change in your anatomy. That being the case, there is some risk, albeit minor, that you may place undue strain on your accommodative mechanism, causing symptoms that may lead (IME) to ciliary hypertonicity. In other words, Rishi's comments about learning to relax have some validity (unfortunately, that's the only valid thing he has ever said). An overly taxed accommodative mechanism can get you into trouble. Working hand-in-hand with a good eye doctor throughout can elicit these functional accommodative changes. IOW, he/she can tell you whether you're "getting better" or simply "working harder." The former is a good thing, and has eluded both medicine and science. The latter is rather simple, but not highly recommended. Also, it would be good if you were able to quote in your replies, so that we can more easily determine to what you are responding. Neil, You stated, "What you're likely to find is an increasing reliance on your accommodative system, rather than any underlying change in your anatomy. That being the case, there is some risk, albeit minor, that you may place undue strain on your accommodative mechanism, causing symptoms that may lead (IME) to ciliary hypertonicity." Do you have any links that I can use to read up on ciliary hypertonicity? Also, I started working on my vision improvement with a behavioral OD. She did not do any specific test on my ciliary hypertonicity that I know of. She has also not advized me to come in for periodic visits. In your opinion is this an error then or more risky approach? Is there a way you know of for me to continue with vision improvement and yet reduce any risks? Thanks! >You stated, "What you're likely to find is an increasing reliance on your >accommodative system, rather than any underlying change in your [quoted text clipped - 3 lines] > >Do you have any links that I can use to read up on ciliary hypertonicity? You can look at Accommodative excess here: Accommodative excess (or spasm) can be caused by underlying neurologcal issues (e.g., result of a motor vehicle accident), or hypertonicity -- the cumulative result of sustained strain on the accommodative mechanism. Accommodative Excess: http://www.indiana.edu/~v755/acc/acctx.htm Tonic Accommodation: http://tinyurl.com/5dmb4 Tonic Accommodation is the resting level of accommodation. In my particular case, the amount of tonic accommodation rose over years as I tried to compensate for having been overminused at near. >Also, I started working on my vision improvement with a behavioral OD. She >did not do any specific test on my ciliary hypertonicity that I know of. >She has also not advized me to come in for periodic visits. As I implied, I think the likelihood of pushing these sorts of therapy to the point of any irreversible accommodative spasm is very remote. The likelihood of over-taxing your accommodative system to the point of symptoms (headache, itching, burning, fatigue, ocular ache) is greater. >In your opinion is this an error then or more risky approach? I see very little downside in periodic visits--again, particularly to elicit the degree to which your "improvement" is really more a) pseudomyopia (increased tonic accommodation > hypertonicity), or b) merely a greater reliance on your accommodative system. If you are blesses with a very facile accommodative system, then you may improve your *perception* of your eyesight with little consequence, though you would be hard pressed to prove any physiological change had occurred. >Is there a way you know of for me to continue with vision improvement and >yet reduce any risks? Work in concert with a trusted ophthalmologist or optometrist -- preferably *not* the one who is "prescribing" the vision therapy. Do you see any downside in that? [quoted text clipped - 7 lines] >You can look at Accommodative excess here: Accommodative excess (or >spasm) can be caused by underlying neurologcal issues (e.g., result of >a motor vehicle accident), or hypertonicity -- the cumulative result >of sustained strain on the accommodative mechanism. >Accommodative Excess: http://www.indiana.edu/~v755/acc/acctx.htm >Tonic Accommodation: http://tinyurl.com/5dmb4 >Tonic Accommodation is the resting level of accommodation. In my >particular case, the amount of tonic accommodation rose over years as >I tried to compensate for having been overminused at near. >>Also, I started working on my vision improvement with a behavioral OD. She >>did not do any specific test on my ciliary hypertonicity that I know of. >>She has also not advized me to come in for periodic visits. >As I implied, I think the likelihood of pushing these sorts of therapy >to the point of any irreversible accommodative spasm is very remote. >The likelihood of over-taxing your accommodative system to the point >of symptoms (headache, itching, burning, fatigue, ocular ache) is >greater. >>In your opinion is this an error then or more risky approach? >I see very little downside in periodic visits--again, particularly to >elicit the degree to which your "improvement" is really more a) [quoted text clipped - 3 lines] >your *perception* of your eyesight with little consequence, though you >would be hard pressed to prove any physiological change had occurred. >>Is there a way you know of for me to continue with vision improvement and >>yet reduce any risks? >Work in concert with a trusted ophthalmologist or optometrist -- >preferably *not* the one who is "prescribing" the vision therapy. Do >you see any downside in that? Thanks you Neil! Those are excellent suggestions. You make a good point. I will go to a different optometrist for follow up exams. I am sure she can conclude if there are any physiological changes that have occurred. If my *perception* changes though to 20/20, then I will be an extremely grateful man indeed. Hi- I am usually too busy to post these days, but I believe you would benefit from my reply: You aren't being that specific about what the Behavioral OD is doing for you, how often, or even if you actually are having a course of vision therapy. First of all you should have been given a very extensive series of tests, a comprehensive eye exam, which takes hours, and is called "the 21-point test." In the process ciliary hypertonicity, ciliary spasm, vergence problems, etc. would be observed if they are present. If no such series of tests has been given you, the OD was quite remiss and how could he/she advise a course of treatment for you? I don't know what the prospect of success might be in your particular case, but in my case accommodative spasm and insufficiency, convergence insufficiency, and other vision problems were remedied by a full course of vision therapy. It was definitely uncomfortable in the beginning, with resulting tearing, fatigue, etc. which are typical. As the patient progresses, the exercises tend to become easier and less uncomfortable and finally not uncomfortable at all. Best regards, Francine http://groups.yahoo.com/group/focus_on_vision_training/ ........... > Neil, > [quoted text clipped - 16 lines] > > Thanks! "Jamie M via MedKB.com" <forum@MedKB.com> wrote > Is there a simple way to determine whether an individual is a functional > or > anatomical myope? Yup. A couple of doses of cyclopentolate, 15 min apart, and thirty minutes later blue-eyed people will be pretty near "absolute cycloplegia." _Presumably_ this is at or near the "anatomical" limit of relaxed accommodation and represents the "true" myopia. > Is it possible that minus lenses can harm or exacerbate the severity of > myopia in an individual? If it's possible, it doesn't show up when we compare groups of myopes wearing corrective lenses versus groups who don't wear lenses. If it's possible, to any practical degree, it would show up. Studies like Parsinnen and COMET would show dramatic results. They don't. > If the myopic condition started as functional will it necessarily change > to > an anatomical one with age, time, damage, use of minus lenses? Some optometrists still cling to this belief, but again, if groups of people wearing excessive correction don't get worse, then "possibility" isn't enough to recommend a procedure. > What percentage of myopia is functional vs anatomical? It varies, of course. In 55-year-olds, virtually none of their myopia is "functional". In some 15-year-olds, it's 5 diopters of accommodation added to 3 D anatomical. Even more, for short episodes, like when they sit for refraction.:) Realize that other 15-year-olds who are 5 D _farsighted_ are exerting exactly the same effort when they don't wear glasses (and they often don't.) Farsighted kids don't get nearsighted or suffer any consequences other than strain and headache when they go without glasses. Their (anatomical) refraction doesn't really change whether they wear glasses or not. Myopic kids either. -MT > Mike, > [quoted text clipped - 7 lines] > or > anatomical myope? Yes, compare your cycloplegic refraction to your non cycloplegic refraction. The cycloplegic result is anatomical, the difference, if any, between the two is the amount of functional. > Is it possible that minus lenses can harm or exacerbate the severity of > myopia in an individual? No evidence of this exists. > If the myopic condition started as functional will it necessarily change > to > an anatomical one with age, time, damage, use of minus lenses? Not likely, most functional actually disappears around age 35 to 45. > What percentage of myopia is functional vs anatomical? > > Thanks, > > Jamie Dear Friends, Subject: Understanding the pressure on an OD to produce a minus-lens quick-fix. Also the pressure "conformity" on an OD to supply that superfical quick fix -- and the long term consequences. Re: Separation between "medicine" and pure-science -- the REALITY. No. But if we start some "therapy to slow myopia," Mom will talk it over with her pediatrician and he'll insist that she take the kid to a "real doctor." That's the reality. -- MT ___________________ This is EXACTLY the staement made by Dr. Raphaelson a long time ago. Unless the person (or his parent) is willing to go through an "educational" process, the traditional quick-fix of the minus lens will continue. This suggests the need for an "open" conversation about the proven behavior of the natural eye (pure-science) the dynamic nature of the natural eye. This discussion should be "automatic". If the parents (after reviewing the various issues) decide to reject the plus, then the eye is simply going to go "down" at about -1/2 diopter per year. The OD, offering "prevention" on the threshold would have no further responsibility for the consequences of wearing that minus lens all the time. This is Steve Leung's OD thesis. Folks -- we need to re-think this process of nearsighedness development. We need to understand personal responsibility and choice in this matter. Best, Otis Engineer > Subject: Understanding the pressure on an OD to produce > a minus-lens quick-fix. Also the pressure "conformity" > on an OD to supply that superfical quick fix -- and the > long term consequences. There is pressure on you to produce citations showing that children who wear minus get more nearsighted than children who don't. For, what, 2 years now we've been asking you and you never have responded to this question. > This is EXACTLY the staement made by Dr. Raphaelson a long > time ago. Unless the person (or his parent) is willing to > go through an "educational" process, the traditional > quick-fix of the minus lens will continue. So Dr. Raphaelson published results showing groups of children who got less nearsighted? > This suggests the need for an "open" conversation about > the proven behavior of the natural eye (pure-science) the > dynamic nature of the natural eye. It suggests a need for you to explain why medical doctors all disagree with "pure-science".. > The OD, offering "prevention" on the threshold would > have no further responsibility for the consequences > of wearing that minus lens all the time. And what if "prevention" doesn't work? > This is Steve Leung's OD thesis. I'd be interested to see if he makes plus therapy work on populations of children. I haven't had much luck with it, nor have other doctors. > Folks -- we need to re-think this process of > nearsighedness development. Well, some of us. > We need to understand personal responsibility and > choice in this matter. That's right. Your want your doctor recommending unproven therapies. -MT ***** OTIS WARNING ***** This posting is an automatic reply to any sci.med.vision newsgroup thread that is receiving comments from a person named "Otis", "Otis Brown", "otisbrown@pa.net" or "Otis, Engineer". Otis is not an expert in any field of vision. His medical and eyecare training is nil. He is a proponent of a myopia prevention technique that is unproven. Otis continually misquotes people in his posts. He drops the names of doctors whom he falsely claims to be associated with. He has been caught in out-and-out lies. He has given people incorrect medical advise. Sadly, his behavior suggests he may have psychological problems that compel him to argue against people just for the sake of causing an argument. Otis is what is known in internet newsgroup lingo as a "troll". Do not reply to his postings-- it just takes up bandwidth and storage space that should be reserved for meaningful topics. It also just fulfils his sick psychological needs. No one means to suppress the honest opinions of others. This message is only meant to forewarn newcomers who might misconstrue Otis as a trained eyecare expert. Those of us who have been here for awhile know Otis oh too well! For anyone who is interested in understanding the true state of scientific/medical research on myopia prevention, I offer the following links: http://annals.edu.sg/pdf200401/V33N1p4.pdf http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/apr01/lesson_0401.htm http://dels.nas.edu/ilar/jour_online/40_2/V40_2NortonAnimalModels.asp http://www.optometrists.asn.au/gui/files/ceo865276.pdf If you are truly interested in Otis' theories of myopia prevention then visit his favorite websites www.i-see.org and www.chinamyopia.com. Please see the weekly posting "welcome to sci.med.vision", which usually appears on Mondays, for a guide regarding this newsgroup and for information on how to filter out Otis' posts so that you may be able to participate in worthwhile discussions in this forum. For further information on killfilling (filtering out the posts of a troll or spammer) see the following link: http://www.hyphenologist.co.uk/killfile/killfilefaq.htm For additional information on handling "trolls" like Otis, refer to this link: http://www.hyphenologist.co.uk/killfile/anti_troll_faq.htm =================================================== > Dear Friends, > > Subject: Understanding the pressure on an OD to produce > a minus-lens quick-fix. Also the pressure "conformity" > on an OD to supply that superfical quick fix -- and the > long term consequences. |
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